September 8, 2009 in Features

People’s Pharmacy: Propofol doesn’t deserve bad rap


Before Michael Jackson’s tragic death, most people had never heard of the drug propofol (Diprivan). It’s not the kind of medication that anyone would ever seek out on the street. You can’t use it to get high. In fact, you can’t use it on yourself at all.

This injectable medicine is used to induce anesthesia. It takes effect very quickly, within 30 seconds to a minute, and wears off quickly as well. As a result, it is often used for diagnostic procedures such as colonoscopies, as well as in the operating room when people are having the gallbladder or an appendix removed.

Anesthesiologists love propofol because when administered correctly, it is one of the safest drugs used during surgery, safer, in fact, than Versed (midazolam). Versed is a Valium-like sedative that is often used along with a narcotic pain reliever such as Demerol for colonoscopies and similar procedures.

Unfortunately for Jackson, news reports indicated he received an astonishing cocktail of sedatives before he died. They included diazepam (Valium), lorazepam (Ativan) and midazolam (Versed). Some of these may have been given more than once. Later, cardiologist Conrad Murray administered propofol intravenously to knock Jackson out.

With so many different central-nervous-system depressants circulating in his body, it is little wonder that Jackson stopped breathing. All these drugs can work together to slow or stop respiration.

In an operating room, the anesthesiologist would be carefully monitoring patient breathing and oxygen saturation. If respiration becomes too slow, countermeasures are taken immediately to prevent complications.

The moral of this story is not that propofol is dangerous. The drug remains extremely useful in the proper setting. Anyone who thinks this happens only to celebrities is sadly mistaken. Dr. Murray and his patient both exercised poor judgment, but drug interactions are commonplace in medicine.

Each year people die because they receive prescriptions for incompatible medications. Something as seemingly simple as ibuprofen purchased over the counter for a bad backache could lead to a life-threatening bleeding ulcer when taken with the blood thinner warfarin (Coumadin).

There are so many deadly combinations that it is difficult to keep track of them all. Someone taking the drug methotrexate for psoriasis or rheumatoid arthritis might be prescribed the antibiotic co-trimoxazole (Bactrim, Septra) for a urinary-tract infection. The antibiotic makes methotrexate much more toxic and can result in serious blood changes that can be fatal.

Readers who would like to know more about the dangers of mixing and matching common medications may wish to consult our book “Dangerous Drug Interactions.” It is available from libraries, local booksellers or online at

To avoid becoming a sad statistic, make sure your pharmacist and your physician always double-check everything you take for possible interactions. Even herbs and dietary supplements can produce unexpected and hazardous reactions with certain prescribed medications.

Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. E-mail them via their Web site:

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